The ‘fog of war’ over malaria drug

AS debate rages over the likelihood of a ‘second wave’ of Covid-19, experts continue to examine the question of whether effective treatments exist.

One thing that we have to bear in mind is that, even if useful treatments are found, there will be serious difficulties in building policy or plans around them while these drugs are still undergoing tests.

One particularly bruising skirmish has taken hold in the United States over whether the anti-malaria drug hydroxychloroquine (a treatment that has been around for decades) can ease suffering from Covid-19 and save lives.

More than 50 countries around the world are receiving imports of the drug. Healthcare staff in the US and India have been reported to be using it prophylactically. Some patients who took it believe it to have been effective. However, some questions have been raised about its safety and efficacy.

In mid-April I pointed to the mysteries surrounding hydroxychloroquine, including the question of whether Boris Johnson was given the treatment at St Thomas’ Hospital, London. Aseparate question was: If used, did it aid the PM’s recovery?

We have still not had clear answers to that question, although anecdotal reports from apparently reliable sources suggested not. However, it would certainly be interesting to know what, if anything, the PM was treated with.

I also attempted to lay out some of the evidence, anecdotal or otherwise, for or against the effectiveness of this drug, especially when used in combination with both the antibiotic azithromycin and zinc. Lord (Matt) Ridley has noted, ‘there are persistent and reliable reports that zinc either stops viruses replicating or helps the immune response to them.’

During April, we started to hear negative stories, especially about potential side-effects of the treatment. There are some examples of headlines below:

On April 11, it was reported that France’s drug safety agency had released data indicating that hydroxychloroquine appears to have serious side effects for the heart when used for Covid-19 patients.

On April 24, the United States Food and Drug Administration cautioned against use of hydroxychloroquine or chloroquine for Covid-19 outside a hospital setting or a clinical trial due to risk of heart rhythm problems.

A Brazilian study investigating whether chloroquine was effective in treating patients with Covid-19 was halted after a high dose proved lethal for some patients.

A study conducted in a veterans’ hospital concluded there was no overall benefit, and that there were more deaths among patients treated with hydroxychloroquine alone. It should be added that a number of strong reservations have been expressed about the utility of this study in demonstrating effectiveness or not, not least by the Secretary of Veterans Affairs and by Dr Stephen Smith of Smith Center for Infectious Disease. Dr Smith is an example of a physician who believes in the treatment. On the basis of his own work with patients near New York, he said it could be a ‘game changer’ in the fight against Covid-19.

It is also important to put the negative headlines into the global context. Hydroxychloroquine is being, or has been, used around the world, for instance in Italy, Spain and Malaysia. On April 11, the Indian Council of Medical Research said that hydroxychloroquine should be used as a prophylaxis to prevent the coronavirus.

In recent weeks, a number of headlines have balanced the pessimism. For example:

In late March, the Kingdom of Bahrain reported that its hospitals were successfully treating coronavirus patients with hydroxychloroquine. Bahrain’s Supreme Council of Health chairman said its impact has been ‘profound’.

On April 17, a piece published in the Lancet noted that ‘in-vitro studies have shown that chloroquine is effective against several viruses, including severe acute respiratory syndrome coronavirus . . . effective drugs such as chloroquine and its related formulations might prevent infection . . . or the development of severe symptomatic disease . . . substantially reducing morbidity and mortality due to Covid-19.’

On April 28, the Association of American Physicians and Surgeons wrote a letter to the Governor of Arizona enclosing a frequently updated table of studies which reported the results of treating Covid-19 with chloroquine and hydroxychloroquine. The letter said that, to date, the total number of reported patients treated with it, with or without zinc and azithromycin, was 2,333. Of these, 2,137, or 91.6 per cent, improved clinically.

On April 29, Dr William W O’Neill, medical director of the Center for Structural Heart Disease at Henry Ford Hospital in Detroit, said: ‘In the early phase, I have empirically treated people with a combination of hydroxychloroquine, azithromycin and zinc. That combination, at least in my hands, has been really effective. I am leaning toward the side of being a believer or an early adopter.’ New study to provide insight on hydroxychloroquine for COVID-19 prevention in health care workers

Whatever the truth, the picture on treatment of Covid-19 is sadly not that much clearer than it was a fortnight ago. Instead of helping to clear the ‘fog of war’, some journalists are helping to make it more impenetrable. The world deserves better from those who are meant to hold the powerful to account.

The purpose of this piece is to highlight specific aspects of a topic of major concern for readers in the hope that it might be more effectively addressed, in the interest of public information, by the UK authorities and by the media. It does not seek to offer expert opinion about medical treatment, nor is the author qualified to do so. Medical advice, and advice about treatment, should be sought only from a qualified professional.

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